Healthcare Provider Details

I. General information

NPI: 1457330870
Provider Name (Legal Business Name): FRIEND FAMILY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5843 S. WESTERN AVENUE
CHICAGO IL
60636
US

IV. Provider business mailing address

5843 S. WESTERN AVENUE
CHICAGO IL
60636
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-2193
  • Fax: 773-702-4356
Mailing address:
  • Phone: 773-702-2193
  • Fax: 773-702-4356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SABRINA MODRE
Title or Position: CFO
Credential:
Phone: 773-702-2193